Swedish Physicians Research Articles

Associations between job demand-control-support and high burnout risk among physicians in Sweden: a cross-sectional study

BackgroundThe knowledge about job demands, control, and support, and their potential associations with burnout risk among physicians in Sweden, is limited. This study aimed to explore (i) factors of the JobDemand-Control-Support (J-DCS) model across different groups of physicians in Sweden, (ii) their association with high burnout risk, and (iii) the potential buffering impact of job control and support.MethodsCross-sectional data from the Swedish Longitudinal Occupational Health in Healthcare Survey (LOHHCS) study cohort was used. In 2021, a total of 2032 respondents submitted questionnaire data comprising J-DCS measures (i.e., job demands, workplace control and task-level control, and social support from peers and managers). Burnout risk was measured using the Burnout Assessment Tool. Binary logistic regression models were used to investigate the associations between the J-DCS variables and high burnout risk. Interaction analysis was performed to explore any moderation of the associations.ResultsJob demands were significantly associated with increased odds of high burnout risk (odds ratio (OR) 2.71, 95% confidence interval (CI) 1.91–3.84. Workplace control (OR 0.50, 95% CI 0.35–0.71) and peer support (OR 0.61, 95% CI 0.48–0.77) were significantly associated with reduced odds of high burnout risk. The interaction analysis showed no significant moderation of the association between job demands and high burnout risk by either peer support or workplace control, and no buffering impact was found.ConclusionJob demands were associated with high burnout risk among physicians in Sweden. Although workplace control and peer support had inverse associations with high burnout risk, no moderation or buffering impact on the association between job demands and high burnout risk was found. Longitudinal studies are needed to confirm these associations.

Pediatric head injury guideline use in Sweden: a cross-sectional survey on determinants for successful implementation of a clinical practice guideline

BackgroundThe Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.MethodsThis is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.ResultsOf 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.ConclusionsThe findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.

Impact of work-life interference on burnout and job discontent: A one-year follow-up study of physicians in Sweden.

In recent years, increased physician workload has led to higher levels of interference between work and private life with increasing stress and job discontent. The objective of this paper was to study if the experience of work-life interference (WLI) is associated with a high risk of burnout and discontent with work (turnover intention and job dissatisfaction) the following year among physicians in Sweden. The study applied data for 2021 and 2022 from the Longitudinal Occupational Health survey for Health Care professionals in Sweden study. The data comprised a representative sample of physicians (N=1575) working in Sweden. Descriptive analyses included frequencies and estimates of prevalence with Chi-square and McNemar tests. Analyses of association were assessed through logistic regression reporting odds ratios (OR) and 95% confidence intervals (CI) adjusting for demographics and work-related factors. Higher levels of WLI in 2021 were associated with 1.53 (95% CI 1.05-2.25) times higher odds of reporting a high risk of burnout, 2.06 (95% CI 1.68-2.54) times higher odds of reporting job dissatisfaction, and 1.72 (95% CI 1.47-2.00) times higher odds of reporting turnover intention in 2022. Experiencing WLI negatively affects mental well-being and work satisfaction among physicians in Sweden. This could ultimately impact the quality of care and necessitates further research to clarify the role of WLI among healthcare workers in Sweden.

Associations between effort-reward imbalance and risk of burnout among Swedish physicians.

The high prevalence of burnout among Swedish physicians may have several possible effects on individuals and society. However, further investigations of work-related factors associated with the risk of burnout among Swedish physicians are needed. We aimed to study the associations between psychosocial work factors, based on the effort-reward imbalance (ERI) model, and the risk of burnout among Swedish physicians. A representative sample of 7200 Swedish physicians was invited in 2021. Data were gathered through questionnaires, with a response rate of 41%. Logistic regression models were used to study the associations between exposure to ERI and the risk of burnout. Approximately 62% of Swedish physicians were exposed to a high ERI. Exposure to a high ERI was associated with 11 times increased risk (95% confidence interval 6.5-20.0) of burnout in adjusted models. Large variations in the prevalence of ERI and risk of burnout across sociodemographic and occupational factors were identified, particularly across different clinical specialties. A majority of Swedish physicians were exposed to high levels of work-related stress, strongly associated with an increased risk of burnout. This population-based cross-sectional study underlines the need to further study variations of work-related stress across clinical specialties and to monitor occupational health among physicians longitudinally.

Assisted dying in Swedish healthcare: a qualitative analysis of physicians’ reasoning about physician-assisted suicide

To explore Swedish physicians’ arguments and values for and against physician-assisted suicide (PAS) extracted from the free-text comments in a postal survey. A random selection of approximately 240 physicians from each of the following specialties: general practice, geriatrics, internal medicine, oncology, surgery and psychiatry. All 123 palliative care physicians in Sweden. A qualitative content analysis of free-text comments in a postal questionnaire commissioned by the Swedish Medical Society in collaboration with the Karolinska Institute in Stockholm. The total response rate was 59.2%. Of the 933 respondents, 1107 comments were provided. The free-text comments entailed both normative and factual arguments for and against PAS. The analysis resulted in two main categories: (1) “Safe implementation of PAS is unachievable” (with subcategories “Criteria of PAS difficult to fulfil” and “PAS puts societal norms and values at risk”) and (2) “The role of PAS in healthcare” (with subcategories “No medical need for PAS”, “PAS is not a task for physicians”, “No ethical difference to other end-of-life decisions” and “PAS is in the patient’s best interest”). The respondents brought up well-known arguments from academic and public debate on the subject. Comments from physicians against PAS were more often emotionally charged and used devices like dysphemisms and slippery-slope arguments.

Diagnostic methods and written advice for acute otitis media in primary health care

Background Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway. Methods This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country. Results Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10–0.23; p < .001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070–0.027; p < .001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010–0.078; p < .001) and tympanometry, adjusted OR 0.31 (95% CI 0.21–0.45; p < .001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1–6.7; p < .001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45–0.93; p = .019) and 0.63 (95% CI 0.43–0.92; p = .016). Conclusions Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy.

The management of heart failure in Sweden-the physician's perspective: a survey.

To assess the barriers to guideline-directed medical therapy (GDMT) use in heart failure (HF), diagnostic workup and general knowledge about HF among physicians in Sweden. A survey about the management of HF was sent to 828 Swedish physicians including general practitioners (GPs) and specialists during 2021-2022. Answers were reported as percentages and comparisons were made by specialty (GPs vs. specialists). One hundred sixty-eight physicians participated in the survey (40% females, median age 43 years; 41% GPs and 59% specialists). Electrocardiography and New York Heart Association class evaluations are mostly performed once a year by GPs (46%) and at every outpatient visit by specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). One-third of participants screen for iron deficiency only if there is anemia. Major obstacles to implementation of different drug classes in HF with reduced ejection fraction are related to side effects, with no significant differences between specialties. Device implantation is deemed appropriate regardless of aetiology (69%) and patient age (86%). Specialists answered correctly to knowledge questions more often than GPs. Eighty-six percent of participants think that GDMT should be implemented as much as possible. Most participants (57%) believe that regular patient assessment in nurse-led HF clinics improve adherence to GDMT. Obstacles to GDMT implementation according to physicians in Sweden mainly relate to potential side effects, lack of specialist knowledge and organizational aspects. Further efforts should be placed in educational activities and structuring of nurse-led clinics.

Physicians’ intentions to use digital tools – a comparative survey, before and after the COVID-19 pandemic, in Southern Sweden

Objectives To describe changes in Swedish primary care physicians’ use of, attitudes and intentions toward digital tools in patient care between 2019 and 2022. Design A survey using a validated questionnaire measuring physician’s intentions to use digital tools based on the theory of planned behavior. Setting Sample of primary health care centers in southern Sweden. Subjects Primary care physicians. Main outcome measures Self-reported use and intentions to use, digital tools including digital consultations by text or video, chronic disease monitoring and artificial intelligence (AI) and the associations between attitudes, subjective norms, perceived behavioral control and behavioral intentions to use digital tools, in 2019 compared to 2022. Results In both 2019 (n = 198) and 2022 (n = 93), physicians reported high intentions to use digital tools. Self-reported use of video was slightly higher in 2022 (p = .03). No other changes were seen in the self-reported use or behavioral intentions to use digital tools. Conclusion The slow adoption of patient-related digital tools in Swedish primary health care does not seem to be explained by a low intention to use them among physicians. Future research on implementation of digital tools should include a focus on contextual factors such as organizational, technical and cultural barriers.

Sjögren: unique surname, two men, four syndromes and one disease.

Henrik and Torsten Sjögren (/'ʃoʊɡrən/ or SHOH-grən) were two Swedish physicians living in the same period, but completely unrelated, except for their notable contributions to Medicine. The first one described keratoconjunctivitis sicca, afterward called Sjögren's syndrome, and a fishing net aspect retinal pigmentation affecting visual acuity, nowadays known as Sjögren reticular dystrophy. The last one contributed to the understanding of Spielmeyer-Sjögren disease, Marinesco-Sjögren, and Sjögren-Larsson syndromes, all related to genetic disorders and neurological symptoms. In this paper, we aim to describe each disorder, in order to avoid any misunderstanding in diagnosis and for historical record.

Long time in the waiting room: migrant physicians in Sweden and their struggles to mobilise cultural capital

ABSTRACT The mobilisation of assets from one national field to another is a topic that has attracted significant sociological attention. In this paper, we investigate migrant physicians who obtained their medical degrees outside the EU/EEA and trace the process of validating their degrees in Sweden. The study is inscribed in Bourdieu’s sociological tradition and is based on a questionnaire and interviews with physicians. Analysing the mobilisation of cultural capital across national borders, we emphasise the importance of distinguishing its different states in the context of migration. Based on our case, we argue that the time physicians spend in the ‘waiting room’ challenges their ability to maintain and perform their medical craft. We show that the time it takes to institutionalise assets and accumulate capital in another national context can lead to the risk of losing its embodied state.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BackgroundSomatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians’ awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.MethodsA web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 – January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher’s exact test.ResultsOf the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.ConclusionsAwareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

Perceptions of Clinical Experience and Scientific Evidence in Medical Decision Making: A Survey of a Stratified Random Sample of Swedish Health Care Professionals.

Evidence-based medicine recognizes that clinical expertise gained through experience is essential to good medical practice. However, it is not known what beliefs clinicians hold about how personal clinical experience and scientific knowledge contribute to their clinical decision making and how those beliefs vary between professions, which themselves vary along relevant characteristics, such as their evidence base. We investigate how years in the profession influence health care professionals' beliefs about science and their clinical experience through surveys administered to random samples of Swedish physicians, nurses, occupational therapists, dentists, and dental hygienists. The sampling frame was each profession's most recent occupational registry. Participants (N = 1,627, 46% response rate) viewed science as more important for decision making, more certain, and more systematic than experience. Differences among the professions were greatest for systematicity, where physicians saw the largest gap between the 2 types of knowledge across all levels of professional experience. The effect of years in the profession varied; it had little effect on assessments of importance across all professions but otherwise tended to decrease the difference between assessments of science and experience. Physicians placed the greatest emphasis on science over clinical experience among the 5 professions surveyed. Health care professions appear to share some attitudes toward professional knowledge, despite the variation in the age of the professions and the scientific knowledge base available to practitioners. Training and policy making about clinical decision making might improve by accounting for the ways in which knowledge is understood across the professions. Study participants, representing 5 health care professions-medicine, nursing, occupational therapy, dentistry, and dental hygiene-viewed science as more important for decision making, more certain, and more systematic than their personal clinical experience.Of all the professions represented in the study, physicians saw the greatest differences between the 2 types of knowledge.The effect of years of professional experience varied but tended to be small, attenuating the differences seen between science and clinical experience.

How do clinicians use post-COVID syndrome diagnosis? Analysis of clinical features in a Swedish COVID-19 cohort with 18 months’ follow-up: a national observational cohort and matched cohort study

IntroductionSARS-CoV-2 infection causes acute COVID-19 and may result in post-COVID syndrome (PCS). We aimed to investigate how clinicians diagnose PCS and identify associated clinical and demographic characteristics.MethodsWe analysed multiregistry data...

National survey of physicians in Swedish child health centres finds insecurity and unawareness regarding management of undescended testicles.

To investigate underlying factors for previously reported shortcomings in child health centres' (CHC) referral process of boys with undescended testicles. A total of 386 physicians working at Swedish CHCs were surveyed regarding their knowledge about undescended testicles and their clinical management. Multivariate regression analyses were performed to identify risk factors of non-adherence to guidelines and self-reported lack of clinical skills. The overall knowledge of the health benefits of undescended testicle surgery was high (89%), while two-thirds were unaware of surgery being recommended <1 year of age. One-fifth of respondents had never received guidance on examination techniques. Male gender (adjusted odds ratio [aOR] 0.51, 95% confidence interval [95% CI] 0.31-0.86), education in paediatrics (aOR 0.37, 95% CI 0.18-0.76) and more experience (aOR 0.02, 95% CI 0.01-0.09) significantly decreased the risk of unfamiliarity with examinations. More experience decreased the risk of stating the incorrect indications for undescended testicle surgery (aOR 0.17, 95% CI 0.03-0.95) and finding examinations difficult (aOR 0.22, 95% CI 0.07-0.72). Medical education outside Nordic countries was a risk factor for unawareness of guidelines (aOR 2.06, 95% CI 1.21-3.51). The knowledge and confidence level of the study population varied widely. The results indicate a need for further theoretical and practical education among Swedish CHC physicians.

The management of patients with heart failure in Sweden: a survey conducted among physicians in Sweden

Abstract Background Guideline-directed medical therapy (GDMT) improves outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world studies highlight underutilization of GDMT. Purpose To describe physicians´ general knowledge and opinions on GDMT use, diagnostic workup, and follow-up care in HF in Sweden. Methods A survey comprising 42 multiple-choice questions about HF and its management was sent by mail to a random sample of 828 physicians including any specialist, general practitioners (GP) and interns in Sweden during 2021 and 2022. Answers were reported as percentages and comparisons were made by specialty (general practitioners vs specialists) by the chi-square test. Results 168 physicians (60% males, median age 43) responded to the survey (response rate: 20%), of whom 41% GPs, 18% cardiologists and 13% internists, 24% specialists in training, and 4% other specialists; 72% of participants report to meet less than 10 HF patients per week. Electrocardiography and a New York Heart Association class evaluation are mostly performed once a year by GPs (46%) and at every outpatient visit by other specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). 85% of the participants reported to never assess patient-reported parameters and outcomes with questionnaires. One-third of participants screen for iron deficiency only if there is anemia, and 45% do it every year. Figure 1 reports the major measured obstacles to implementation of GDMT in HFrEF; there were no significant differences according to specialty or age of participants. Implantable cardioverter defibrillation (ICD) implantation for primary prevention of sudden death is deemed appropriate by most responders regardless of aetiology (69%) and patient age (74%). ICD or cardiac resynchronization therapy is considered by most after the three months from optimization of GDMT (61%). Specialists answered correctly to questions to test knowledge on GDMT more often than GPs. 86% of participants think that GDMT should be implemented as much as possible, but only 7% estimate that full optimization is reached in more than 75% of their patients. The main reasons why patients with HFrEF do not receive optimal HF medical therapy (Figure 2) reflect the concern about side effects as well as possible knowledge deficiencies. To maximize the adherence to guidelines, 27% reported that patients should be regularly evaluated in tertiary care and 50% in nurse-led clinics, although for 29% of respondents such facilities are not present. Conclusion Obstacles to GDMT implementation according to physicians in Sweden are mainly related to potential side effects, lack of knowledge and structural aspects, including the lack of availability of nurse-led clinics. Improving implementation may require novel strategies, such as improved access to cardiology specialists, more generalizable trials, and potentially screening for GDMT indications.Figure 1Figure 2

Healthcare in distress: A survey of mental health problems and the role of gender among nurses and physicians in Sweden

IntroductionThe present article aimed to investigate 1) if mental health problems (depression and burnout including the dimensions; emotional exhaustion, mental distance and cognitive and emotional impairment) differed between nurses and physicians in Sweden, 2) if any differences were explained by differences in sex compositions, and 3) if any sex differences were larger within either of the two professions. MethodData were derived from a representative sample of nurses (n = 2903) and physicians (n = 2712) in 2022. Two scales were used to assess burnout (KEDS and BAT) and one to assess depression (SCL-6). The BAT scale has four sub-dimensions. Descriptive statistics and logistic regression were used to analyse each scale and dimension separately. ResultsResults showed that 16–28 % of nurses and physicians reported moderate to severe symptoms of burnout. The prevalence differed between occupations across the scales and dimensions used. Nurses reported higher scores on KEDS while physicians reported higher scores on BAT including the four dimensions. Also, 7 % of nurses' and 6 % of physicians' scores were above the cut-off for major depression. The inclusion of sex in the models changed the odds ratios of differences between doctors and nurses in all mental health dimensions except mental distance and cognitive impairment. LimitationsThis study was based on cross-sectional survey data which has some limitations. ConclusionOur study suggests that the prevalence of mental health problems is prominent among nurses and physicians in Sweden. Sex plays an important role in the difference in the prevalence of mental health problems between the two professions.

Challenges in preserving the "good doctor" norm: physicians' discourses on changes to the medical logic during the initial wave of the COVID-19 pandemic.

The COVID-19 pandemic was a tremendous challenge to the practice of modern medicine. In this study, we use neo-institutional theory to gain an in-depth understanding of how physicians in Sweden narrate how they position themselves as physicians when practicing modern medicine during the first wave of the pandemic. At focus is medical logic, which integrates rules and routines based on medical evidence, practical experience, and patient perspectives in clinical decision-making. To understand how physicians construct their versions of the pandemic and how it impacted the medical logic in which they practice, we analyzed the interviews from 28 physicians in Sweden by discursive psychology. The interpretative repertoires showed how COVID-19 created an experience of knowledge vacuum in medical logic and how physicians dealt with clinical patient dilemmas. They had to find unorthodox ways to rebuild a sense of medical evidence while still being responsible for clinical decision-making for patients with critical care needs. In the knowledge vacuum occurring during the first wave of COVID-19, physicians could not use their common medical knowledge nor rely on published evidence or their clinical judgment. They were thus challenged in their norm of being the "good doctor". One practical implication of this research is that it provides a rich empirical account where physicians are allowed to mirror, make sense, and normalize their own individual and sometimes painful struggle to uphold the professional role and related medical responsibility in the early phases of the COVID-19 pandemic. It will be important to follow how the tremendous challenge of COVID-19 to medical logic plays out over time in the community of physicians. There are many dimensions to study, with sick leave, burnout, and attrition being some interesting areas.

The association between self-treatment and mental health among Swedish physicians.

Despite a high prevalence of mental health problems among physicians, the rate of help-seeking behaviour is low. Instead, physicians tend to self-treat. This can have a negative impact on individual physicians and society. The aim was to explore the relationship between self-rated depression, the use of psychotropic medication, and the extent of self-treatment across gender and hierarchical position among Swedish physicians. In addition, the aim was to investigate whether social support can buffer against self-treatment. This study draws on data from the Longitudinal Occupational Health for Health Care in Sweden 2021 study, comprising a representative sample of physicians. Descriptive statistics and logistic regressions were carried out. The present study showed that approximately 60% of the physicians using narcotic or non-narcotic psychotropic medication were self-prescribing. Male and more senior physicians self-treated to a greater extent. Physicians without depression were self-treating to a greater extent than those with depression. Those who used non-narcotic psychotropic medication intermittently were more likely to self-treat than those who used these medications regularly. The frequency of use was insignificant in relation to self-treatment with narcotic psychotropic medication. No buffering effect from social support at work was found. Self-treatment was common among physicians in Sweden, particularly among those who reported mild or no symptoms of depression. This may have negative long-term effects on an individual level and for Swedish health care at large.

An impaired learning environment: Resident physicians' experience of the transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden.

Extensive studies regarding the COVID-19 pandemic have shown negative effects on physicians-in-training. Besides a high workload, their learning environment has been affected. A quality learning environment is vital for residents' physician's clinical development and also their health. Nevertheless, few studies have explored this. The aim of this study was to explore resident physicians' experiences of transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden. In this qualitative study, 12 Swedish resident physicians were interviewed using a semi-structured interview guide. They were interviewed between June and October of 2020 and asked to reflect on the pandemic and, more specifically, the first wave. The empirical material was analysed using qualitative content analysis. The analysis resulted in one theme and four categories. The theme identified was An impaired learning environment which signifies the disruptions the resident physicians experienced during the first wave of the pandemic. The four categories, Professional role insecurity, High expectations but little influence, Stagnant clinical development, and Professional growth through experience, describe in what way the learning environment was impacted.

Money talks: performance-based reimbursement systems impact on perceived work, health and patient care for physicians in Sweden.

The study aimed to investigate in which way performance-based reimbursement (PBR) systems in Swedish healthcare services (1) subjectively impacted physicians' work and patient care and (2) were associated with the occurrence of stress-induced exhaustion disorders among physicians. The study applied a mixed-method design. Data were collected from a representative sample of Swedish physicians. In the questionnaire, respondents were asked to answer an open-ended question regarding their reflections on PBR. The answers to the open-ended question were analysed using thematic analysis. Respondents were also asked to rate the impact of PBR on their work. The association between PBR and self-rated stress-induced exhaustion disease was analysed with logistic regressions. Stress-induced exhaustion disorder was measured using the Burnout Assessment Scale. Thematic analysis resulted in four themes: (1) Money talks, (2) Patients are affected, (3) Medical morals are challenged, and (4) PBR increase the quantity of illegitimate tasks. Logistic regressions showed that physicians who experienced PBR had an impact on their work and had a two-fold higher risk of stress-induced exhaustion disorder. Our findings suggest that current reimbursement systems in Sweden play an essential role in Swedish healthcare and negatively influence physicians' work and health. Also, current PBR impact patients negatively. No previous study has explored the potentially harmful impact of PBR on how physicians perceive work, health and patient care. Results indicate that policymakers should be encouraged to deeply review PBR systems and focus on ways that they can limit the negative impact on physicians' work and health while meeting future challenges.